Study Supports Alarm Fatigue Concern with Physician EHR Use

A Texas-based study reported that primary care physicians and specialists may be overwhelmed by large numbers of notifications from commercial EHR systems.

March 16, 2016 - Authors of a recent study find that physicians spend approximately 66.8 minutes per day processing notifications from EHR use. The study published in JAMA Internal Medicine concludes alarm fatigue to be a significant burden for physicians.

Hospitals are seeing a growing number of EHR platforms being installed because of meaningful use requirements and EHR Incentive Programs. With the healthcare industry quickly transitioning to EHR adoption, healthcare providers are using more commercial EHR inboxes.

Alert fatigue occurs when large numbers of notifications received by EHR software becomes overwhelming for healthcare providers. The use of EHR inboxes makes it easier to send more messages to physicians versus a paper-based system.

These notifications include test results, referral responses, requests for prescription refills, and messages from other healthcare providers. Each notification may contain an array of information that needs to be quickly analyzed and processed.

Dig Deeper

The study investigates of how physicians sift through large numbers of EHR-based notifications to find the important information for quality care.

They cited a previous study from the Department of Veteran Affairs (VA) that found alarm fatigue can lead to more occurrences of missed information and overlooked abnormal test results. The VA study reported that primary care physicians spent an average of 49 minutes going through 56.4 notifications of content each day. This translate to an average of 52 seconds per notification.

The study was conducted by analyzing the EHR inboxes of 92 physicians at 3 large practices in Texas, out of which 19 were primary care physicians and 46 specialists. In total, the researchers went through 276,207 notifications from January 1 to June 30, 2015. This included only 125 work days during the given period.

Researchers calculated that primary care physicians received a mean of 76.9 notifications per day and 15.5 notifications were related to test results. Specialists received 29.1 total notifications per day and 10.4 notifications were related to test results.

They also reported part-time physicians received more notifications in relation to how much time was spent in the office than full-time physicians.

The numbers show that only a small number of notifications related to test results. The majority of other notifications were from other physicians or pharmacies.

“Because a single notification often contains multiple data points (e.g., results of metabolic panels contain 7-14 laboratory values), the actual burden and required cognitive effort required of the physicians is likely greater. Strategies to help filter messages relevant to high-quality care, EHR designs that support team-based care, and staffing models that assist physicians in managing this influx of information are needed,” the researchers wrote in the article.

“The consequence of this well-intentioned generalization is epitomized in the din of chirps, beeps, bells, and gongs that typify hospitals today. It is thus not surprising that concerns regarding safety have emerged, even in populations for whom these protective devices were once considered most valuable,” wrote Vineet Chopra in a 2014 JAMA article.

As if working in a hospital was not distracting enough, with the constant flow of patients and doctors, phone calls, emails, and paperwork, commercial EHR inboxes are adding another level of communication for healthcare providers to monitor.

The study shows that important notifications, like test results, can be lost in a sea of other messages. Instead of providing personalized quality care, EHR technologies can lead to issues with patient safety.

On the positive side, EHR systems do provide healthcare providers with a fast and efficient method of relaying information and data. Compared to a paper-based system, EHR inboxes are streamlining how the healthcare industry receives information.

EHR technologies can also be used to warn physicians about important patient information, such as allergies or negative drug reactions. Automated functions of EHR systems can cause less stress on hospital staff.

The researchers acknowledge that healthcare providers need a way to balance their EHR use, whether it be employing office staff to monitor inboxes or a system that prioritizes messages for physicians. Improvements need to be developed, as the study concludes, to make EHR systems benefit physicians and patients.